為確保合理用藥，減少抗生素濫用，中央健康保險局於民國九十年二月一日起公告增列：「上呼吸道感染病患如屬一般感冒或病毒性感染者，不應使用抗生素」的規定。本院於民國九十年一月，配合健保規範訂定“門診口服抗生素管制條例”，並於二月起執行。我們的目標是期望本院的門診抗生素使用能更適當。
方法：為了達成此目標，臨床藥師由電腦針對所有門診處方中開立抗生素者，比對醫師之診斷及健保規範等相關規定，篩選出不符合規定者，再進一步做病歷查核，確認是否係資料輸入不全或錯誤所造成之“偽”不當抗生素處方，抑或真正不當抗生素處方。其中，主要針對以下兩種的原因，與開方醫師聯絡溝通，持續跟催改善情形，並提報感染小組例會中討論。
1. 門診病患使用口服抗生素使用超過二星期以上。
2. 門診使用口服抗生素時缺乏適當的診斷代碼。
結果：自民國九十年二月，門診口服抗生素管制條例剛實施時，全院門診使用抗生素之處方在實際查核病歷後，使用抗生素不合格率由0.600% 降低至0.026%(Chi Square for linear trend: 52.390, P<0.00001)。我們目前仍進行此門診抗生素管制條例，期許合理適當的使用抗生素，不但可節省醫療成本，並且有效減低細菌抗
藥性的產生。
Introduction :
The Bureau of National Health Insurance in Tai Dan started a neD regulation for controlling the antibiotic usage for patients D ith upper respiratory tract infections to ensure the proper use and to avoid misapplication of antibiotics on Debruary I, 200 I. Dnder the reDuirement of that poliq, De developed an Dantibiotic prescribing guidelineD to prevent the inappropriate use of antibiotics in Shin KongWu Ho-Su Memory Hospital in January and implemented the ned rule in Debruary 200 I. Dur goal Das that the antibiotic usage could be more appropriate in our hospital.
Methods:
In order to achieve such a goal, the clinical pharmacist compared antibiotics prescribed by the doctors D ith patientllsndication and the antibiotic prescribing guideline. We selected out cases in Dhich the antibiotics Dere used inappropriately. These cases Dere sent for further medical chart revieD. Evaluations Dou Id include identifying either a clerical Drong prescription typing or the true case of inappropriate use. ComputeriDed management procedures, auditing of all uses, prescription monitoring, restricted-drug policies, and educational efforts Dere applied. Doctors Dould be asked to raise rationales to infection control routine conunittee to Dustify their use of antibiotics under the folloDing !Do conditions.
1. Dse of oral antibiotics in outpatient therapy for more than 14 days.
2. Prescribing oral antibiotics for the outpatient D ithout a proper diagnostic code.
Results:
After the implementation of this antibiotic prescribing guideline, De observed that the antibiotics Dere more appropriate used in our hospital. The incidents of the improper use of oral antibiotics reduced from 0.600% to 0.026% DChi SDuare for linear trendD 52.390, PD0.0000 I )!'he antibiotic prescribing guideline is still implementing in our hospital. We expected that the development of resistance strains and the related costs could be reduced in our hospital.
